Pathophysiology and management of opioid-induced constipation: European expert consensus statement

Adam D Farmer, Asbjørn Drewes, Giuseppe Chiarioni, Roberto De Giorgio, Tony O’Brien, Bart Morlion, Jan Tack

Publikation: Bidrag til tidsskriftReview (oversigtsartikel)Forskningpeer review

5 Citationer (Scopus)

Resumé

Background: Opioid-induced bowel dysfunction is a complication of opioid therapy, in which constipation is the most common and problematic symptom. However, it is frequently under-recognised and thus effective management is often not instituted despite a number of treatment options. Objective: The central objective of this study is to provide a summary of the pathophysiology and clinical evaluation of opioid-induced constipation and to provide a pragmatic management algorithm for day-to-day clinical practice. Methods: This summary and the treatment algorithm is based on the opinion of a European expert panel evaluating current evidence in the literature. Results: The pathophysiology of opioid-induced constipation is multi-faceted. The key aspect of managing opioid-induced constipation is early recognition. Specific management includes increasing fluid intake, exercise and standard laxatives as well as addressing exacerbating factors. The Bowel Function Index is a useful way of objectively evaluating severity of opioid-induced constipation and monitoring response. Second-line treatments can be considered in those with recalcitrant symptoms, which include gut-restricted or peripherally acting mu-opioid receptor antagonists. However, a combination of interventions may be needed. Conclusion: Opioid-induced constipation is a common, yet under-recognised and undertreated, complication of opioid therapy. We provide a pragmatic step-wise approach to opioid-induced constipation, which should simplify management for clinicians.

OriginalsprogEngelsk
TidsskriftUnited European Gastroenterology Journal
Vol/bind7
Udgave nummer1
Sider (fra-til)7-20
Antal sider14
ISSN2050-6406
DOI
StatusUdgivet - feb. 2019

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Constipation
Opioid Analgesics
Laxatives
Narcotic Antagonists
mu Opioid Receptor
Therapeutics

Citer dette

Farmer, Adam D ; Drewes, Asbjørn ; Chiarioni, Giuseppe ; De Giorgio, Roberto ; O’Brien, Tony ; Morlion, Bart ; Tack, Jan. / Pathophysiology and management of opioid-induced constipation : European expert consensus statement. I: United European Gastroenterology Journal. 2019 ; Bind 7, Nr. 1. s. 7-20.
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Pathophysiology and management of opioid-induced constipation : European expert consensus statement. / Farmer, Adam D; Drewes, Asbjørn; Chiarioni, Giuseppe; De Giorgio, Roberto; O’Brien, Tony; Morlion, Bart; Tack, Jan.

I: United European Gastroenterology Journal, Bind 7, Nr. 1, 02.2019, s. 7-20.

Publikation: Bidrag til tidsskriftReview (oversigtsartikel)Forskningpeer review

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T2 - European expert consensus statement

AU - Farmer, Adam D

AU - Drewes, Asbjørn

AU - Chiarioni, Giuseppe

AU - De Giorgio, Roberto

AU - O’Brien, Tony

AU - Morlion, Bart

AU - Tack, Jan

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N2 - Background: Opioid-induced bowel dysfunction is a complication of opioid therapy, in which constipation is the most common and problematic symptom. However, it is frequently under-recognised and thus effective management is often not instituted despite a number of treatment options. Objective: The central objective of this study is to provide a summary of the pathophysiology and clinical evaluation of opioid-induced constipation and to provide a pragmatic management algorithm for day-to-day clinical practice. Methods: This summary and the treatment algorithm is based on the opinion of a European expert panel evaluating current evidence in the literature. Results: The pathophysiology of opioid-induced constipation is multi-faceted. The key aspect of managing opioid-induced constipation is early recognition. Specific management includes increasing fluid intake, exercise and standard laxatives as well as addressing exacerbating factors. The Bowel Function Index is a useful way of objectively evaluating severity of opioid-induced constipation and monitoring response. Second-line treatments can be considered in those with recalcitrant symptoms, which include gut-restricted or peripherally acting mu-opioid receptor antagonists. However, a combination of interventions may be needed. Conclusion: Opioid-induced constipation is a common, yet under-recognised and undertreated, complication of opioid therapy. We provide a pragmatic step-wise approach to opioid-induced constipation, which should simplify management for clinicians.

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